Strengths
This study carries several strengths. The study design is community based and systematically represent more than 80% of pregnant women newly registered in Anuradhapura, the largest district of Sri Lanka. The study represent a rural population. The results depict follow up of a cohort of pregnant women. Hence the prospective nature implies in prediction of the direction of the association between NAFLD and GDM. We have used the latest WHO criteria for the assessment of GDM. The study has clearly excluded pregnant women who have had all types of hyperglycaemia. Hence the clarity of the association is strong. In addition identification of NAFLD and GDM were performed using measurements adopted to standard protocols.